Senator Chuck Grassley (IA) sent a stinging letter to HHS Secretary Alex Azar, asking why HHS has not adopted recommendations from the Government Accountability Office and the department’s inspector general to improve accountability of SAMHSA’s mental health grants. Since 2015, there have been two GAO reports (Grantee Oversight / PAMI Oversight) that provide specific examples of a lack of oversight over the use of funding. The most recent audit gave SAMHSA failing marks for tracking and evaluating its grant programs. As of September 2016, SAMHSA had 188 outstanding audit recommendations from the HHS inspector general that had yet to be resolved. Among the many requests in the letter to Secretary Azar, Grassley asked for a list of grant programs aimed at preventing violence along with their purpose and how much funding each receives. He also requested metrics on the vetting of grantees and program performance and asked about HHS’s process for evaluating SAMHSA’s grantee awarding decisions, specifically for programs targeting people with serious mental illness. Senator Grassley has set a deadline of today, September 20 to receive the information.

Here is the list of questions that Senator Grassley is asking SAMHSA to respond to by today, September 20th:

Please provide a list of SAMHSA or other HHS grant programs and activities that proactively promote the violence prevention strategies suggested by NTAC [US Secret Service National Threat Assessment Center] (including, e.g., programs that support confidential behavioral health crisis lines, peer-to-peer crisis support services, crisis mobile teams, or initiatives to train school personnel, first responders, and leaders of faith-based communities on the development of systems for identifying and responding to individuals in crisis).

• • Describe the purpose of each program, how it contributes to SAMHSA’s mission, and recent funding information.
  • Please also describe the efforts, if any, made by HHS and its federal partners to inventory all other federal programs supporting individuals with mental illness, as GAO has recommended, and to facilitate intra- and interagency coordination with respect to these activities.
  • If available, please provide materials and checklists used in determination and vetting of a grantee.

How does HHS currently evaluate SAMHSA’s decisions to award funding to programs targeting individuals with mental illness?

• • For example, on what internal mechanisms does SAMHSA rely to determine the appropriate timing of an evaluation to measure each such program’s effectiveness?
  • Please summarize any additional actions that have been taken in response to GAO’s 2014 and 2015 findings relating to SAMHSA’s lack of completed program evaluations.

Has HHS ensured that SAMHSA implemented monthly reconciliations of its audit resolution records with the appropriate oversight offices, as recommended by the HHS OIG in its 2019 report? If not, please explain, and if so, please list the dates when the reconciliations were performed in the current calendar year as well as any related procedure(s) for identifying and completing unresolved audit recommendations.

According to the most recent report issued by the HHS OIG, SAMHSA had 188 outstanding audit recommendations as of September 30, 2016, which have yet to be resolved.

• • What corrective actions has SAMHSA taken to ensure that the backlog of audit recommendations, which were not resolved in a timely manner during FYs 2015 and 2016, are now resolved?
  • Additionally, has the July 2015 draft version of the SAMHSA Internal Policy and Procedures for Resolution of Audit Findings document been finalized? If so, please provide a copy of the finalized version. If not, please provide a detailed explanation for why the policies and procedures were not finalized by the July 31, 2019 deadline.
  • How many of the 188 outstanding audit recommendations have been (1) resolved and (2) for how many has SAMHSA initiated audit resolution efforts, as of September 20, 2019?

I sure hope the Interdepartmental Serious Mental Illness Coordinating Committee is paying attention to these questions as well. They have a required report due to Congress in 2020. Finding answers to these questions might help them in their ongoing quest to improve how federal government distributes funds to improve mental health services in America.

Stay tuned for an update on the Grassley request. We will do our best to get a hold of whatever documentation SAMHSA sends the Senator.